Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1205073269 |
---|---|
Provider Name | Mrs. Blanca Campuzano |
First Address | West Covina, CA 91790-2352 |
Second Address | Los Angeles, CA 90007-2298 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2009 |
Last Update Date | 13/01/2009 |